DESCRIPTION: Public reporting of comparative health care performance information is a central strategy for improving quality of care. This strategy, however, has not been applied to the Leapfrog Group?s three hospital patient safety measures. The Leapfrog Group is sponsored by the National Business Coalition on Health, a coalition of Fortune 500 companies dedicated to mobilizing purchasing power to initiate health care quality improvements and overall health care value. The 3 measures are: 1) computerized physician order entry; 2) staffing the Intensive Care Unit with physicians trained ,as intensivists; 3) evidence-based hospital referral standards linked to patient outcomes and the volume of procedures done. In October 2001, HealthCare 21, a business coalition of health care purchasers and providers in Tennessee, included these hospital patient safety measures in its annual comparative hospital report. Our specific aims are: 1. To compare and contrast the perceptions of health care purchasers and hospital administrators regarding the relative importance of each hospital quality measure and the salience of hospital differences. 2. To determine how health care purchasers use the comparative reports of hospital performance among their employees and for negotiating health coverage. 3. To determine the response of hospital administrators to the report data. We propose a single wave, qualitative evaluation of the novel HealthCare 21 comparative report of hospital performance. To obtain detailed information about how purchasers use the hospital quality information and how and to what extent purchasers distribute the report to their employees, we will interview 30 key purchaser members using telephone interviews. To determine the reaction and response of hospital administrators to the comparative report, we will conduct in-person interviews of 2 senior administrators at each of the 24 hospitals described in the report card. Findings from this evaluation will answer key policy questions about the impact and utility of public disclosure of hospital patient safety measures on purchasers/employers and hospital administrators, the possible pathways for improving hospital performance, and how to increase the impact of future hospital comparative reports.